District of workforce shortage

What is a District of Workforce Shortage?

A District of Workforce Shortage (DWS) is a geographical area in which the local population has less access to Medicare-subsidised medical services when compared to the national average. These areas are identified using the latest Medicare billing statistics, and are updated on an annual basis to account for changes in the composition and geographic distribution of the Australian medical workforce, and the latest residential population estimates as provided by the Australian Bureau of Statistics (ABS).

DWS was introduced in October 2001 and continues to be used to identify areas of Australia that experience the most acute needs for medical services, as evidenced by a comparative shortage of doctors who are billing Medicare.

The Department of Health (the Department) is responsible for making DWS determinations. A DWS is an area identified as having below average access to services attracting a Medicare rebate. This ratio is determined using:
  • the latest Medicare billing statistics, which account for all active Medicare billing and therefore give an accurate indication of the geographic distribution of doctors practising in each medical specialty;
  • the latest estimates of the Australian residential population as provided by the ABS; and
  • local area boundaries that are defined by the Department with consideration of the ABS’s Australian Statistical Geography Standard (ASGS).

How are District of Workforce Shortage for general practice identified?

DWS classifications for general practice are generally provided for geographic areas that are referred to as SA2 boundaries. SA2 boundaries are determined by the ABS as part of the ASGS. In major city areas, the DWS Assessment Area (DWSAA) tend to be SA2s aggregated up to the SA3 level; in remote areas the DWSAA tend to be either a single SA2, or an aggregation of a town’s SA2 and the SA2 of the immediate surrounding area in recognition of the differences in town size and patient catchment. The Medicare billing statistics and ABS population data are used to develop a full-time service equivalent (FSE) GP-to-population ratio for each DWSAA and compared to a national average ratio. DWS determinations that are made as part of this system for general practice are updated annually in the first quarter of the year. Further explanation of FSE methodology can be found in the attachments at: http://www.health.gov.au/internet/main/publishing.nsf/Content/General+Practice+Statistics-1

When determining DWS, the Department compares the FSE GP-to-population ratio for each DWSAA. A DWSAA area will be a DWS for general practice if it is not classified as an inner metropolitan area by the Department and either:
  • the area is classified MM 5 to MM 7 under the Department’s rural and remote geographic structure; or
  • has the same or lower FSE GP-to-population ratio than the current national average (i.e. the Medicare billing statistics show that there are more people for every GP within the area); or
  • it has a FSE GP-to-population ratio that is within up to 10% of the current national average and the GPs practising privately in the area are working 30% harder than the average privately practising GP.

How are Districts of Workforce Shortage for the other specialties identified?

For specialties other than general practice, SA3 boundaries (as defined by the ABS) are used as the relevant DWSAA. These larger geographic areas are used when determining DWS for medical specialists because:
  • there are substantially fewer medical practitioners engaged in private practice in each of these specialities when compared to general practice; and
  • due to lower numbers, these specialists generally service a far larger catchment area than GPs.
The Medicare billing statistics and ABS population data are used to determine the average number of FSE specialists of a type within each SA3 per 100,000 persons residing in the area. The number of FSE specialists per 100,000 persons within each SA3 is then compared with the national average number of specialists per 100,000 persons to identify DWS areas. This methodology applies when making DWS classifications for all specialties other than general practice in relation to all Australian Government programs that use a DWS definition. DWS determinations that are made as part of this system are updated annually.

When applying the Medicare provider number restrictions under section 19AB of the Health Insurance Act 1973 (the Act), DWS areas for medical specialties other than general practice are defined as follows:
  • areas which are classified as outer regional (RA3), remote (RA4) or very remote (RA5) under the ASGS; or
  • areas inside a SA3 that have a lower FSE specialist per 100,000 persons ratio than the current national average.
It should be noted that for some medical specialities the average number of FSE equivalent specialists is not applied, due to the very low number of specialists across Australia. In these instances, these specialties are considered to be in acute shortage, and all areas of Australia are currently considered to be DWS. See the Class exemptions fact sheet for a current list.

Further Advice

Questions relating to the use of DWS determinations when applying the Medicare provider number restrictions of section 19AB can be directed to 19AB@health.gov.au.

Questions relating to the use of DWS determinations for the purpose of determining eligible locations for the purpose of the Bonded Medical Placements Scheme can be directed to: BMPScheme@health.gov.au